P. Akshay Khumar
A Physiological and clinical approach…..
Normal aspects of Menstrual cycle
• Cycle length 20-40 days ( Dec. with age
• Duration of flow of menses 2-7 days
• Avg blood loss 40cc Excess if >80cc
• Menses: 50-75% blood
• Do not usually clot due to the presence of
• Usually unpleasant
• Often associated with cramps
• Mainly due to hormonal withdrawl
Pre-Menstrual syndrome (PMS)
• Occurs for 4 to 5 days prior to menstruation
• It’s due to water and electrolyte imbalance
produced by oestrogen
• Menorrhagia (hypermenorrhea): uterine bleeding excessive in both amount
and duration of flow, but occurring at regular intervals.
• Metrorrhagia: uterine bleeding occurring at irregular intervals.
• Menometrorrhagia: uterine bleeding usually excessive and prolonged
occurring at frequent and irregular intervals
• Oligomenorrhea: menstrual periods at intervals of more than 35 days. (Decreased frequency)
• Polymenorrhea: frequent but regular episodes of uterine bleeding occurring
at intervals of 21 days or less.(Increased Frequency)
• Hypomenorrhea: uterine bleeding that is regular but decreased in amount.
• Intermenstrual bleeding: uterine bleeding, usually not excessive, occurring
at any time during the menstrual cycle other than during normal menstruation.
Dysfunctional uterine bleeding
• Blood flow is usually excessive in duration,
amount and frequency.
• More common during the perimenarcheal and
• Usually episodes are transient and self
• Causes for disturbed function can be central,
intermediate, end organ, and physiologic.
• Central causes: immaturity of the hypothalamic-
pituitary axis; traumatic, polycystic ovarian disease.
• Psychological factors: anxiety, stress, emotional
• Intermediate causes: chronic illness, metabolic or
endocrine diseases, nutritional disturbances.
• Peripheral causes: functional ovarian cyst,
functional tumors, premature ovarian failure
• Physiologic: perimenarcheal and perimenopausal
• Control excessive bleeding and recurrence
• Iron supplements
• Maintain Plasma Volume
• Proper nutrition
• Symptomatic treatment….
• Menstrual disorder is a common complaint.
• Specific pathologies are associated with its
occurrence in different age groups (pubertal
years, reproductive age and
• Requires proper evaluation and specific